Bartonellosis

Description:

Bartonelloses  (bartonellosis - English) combine group of the diseases of the person caused gram-negative aerobic, optionally by the intracellular bacteria needing for the growth hemin or cleavage products of erythrocytes.

Bartonellosis symptoms:

The incubation interval lasts 15 - 40 days, that is usually about 3 weeks, but can drag on up to 3 - 4 months.

In typical cases the disease proceeds dvukhfazno. In the first, acute phase called by fever of Oroya, body temperature increases to 39 - 40 °C and remains at this level 10 - 30 days, then slowly decreases. Fever is followed by the expressed intoxication phenomena, a fever, pouring then. The severe headache, bone, joint and muscular pains, a febricula, sleeplessness, nonsense or apathy, a loss of appetite, nausea, vomiting are noted. On skin there are hemorrhages, the liver and a spleen are increased, jaundice is possible.

At heavy disease the lethality in an acute stage of a bartonellosis reaches 30%, at favorable there comes the asymptomatic phase which in 3 - 6 months can pass into the form of skin rashes (hillocks, spots, the small easily bleeding small knots, hypodermic nodes) called by the Peruvian wart. The last lasts usually 2 - 3 months.

Fever of Oroya - the acute infection which is shown to generalized vasculites, an endocarditis and anemia with a high lethality. An incubation interval - 3 weeks; the disease begins unexpectedly with anorexia, a headache, a fever and disturbance of consciousness. Body temperature usually increases slightly, mialgiya and joint pains, short wind, stethalgias and sleeplessness join later. Development of heavy anemia and various complications is typical. Asymptomatic forms are possible.

The Peruvian wart - a chronic disease with granulematozny skin rashes (the polymorphic red-purple, rigid nodes sometimes reminding Kaposha's sarcoma, formed by growths of capillaries and sometimes containing the activator). It is shown after long stage of latency or an attack of fever of Oroya. Observe educations on integuments more often, but they can appear also on mucous membranes and exist from 1-2 months to several years.

Bartonellosis reasons:

Since 1993 bartonellas are classified in a-2 to subgroup of proteobakteriya of the Bartonellaceae family, phylogenetic by the most related to the sort Brucella that partially explains polymorphism of a clinical picture of the diseases caused by them. For the person pathogens of 5 independent types of bartonellas of various degree of virulence.

In the nature of a bartonella circulate among mouse-like rodents, rats, representatives of the cat family (a cat, a puma) and dogs, causing in them a persistent infection with an asymptomatic current and long months-long bacteremia. Cause in people polymorphic on a clinical picture acute (the Volynsk or trench fever, a disease of Karrionv, Xing. - fever of Oroya), subacute (a disease of cat's scratches) and chronic (a bacillar angiomatosis, the Peruvian wart, purple hepatitis, endocarditises, a long feverish state with bacteremia) diseases.

History. Chronologically the diseases caused by bartonellas were known opening and allocation of activators much earlier. Causative agents of these and other bartonelloses are open, allocated and identified for the XX century, since 1916.

Morphology, identification, cultivation of bartonellas.  Types of bartonellas (till 1993 - Rochalimaea spp., etc.) are microscopically presented by preferential short sticks, 0,3-0,5x1,0-3,0 mm in size. In cuts from the infected fabrics can be curved, polymorphic, are grouped in compact accumulations (clusters). Rounded shapes have 1,5 mm a diameter. Are painted according to Romanovsky-Gimz; in bioptata from fabrics - dye using silver on Warthing Starry; perceive also acridineorange dye that is used in immunochemical researches. 1-4 flagellums located on one of cell poles and therefore it is mobile are characteristic of B. bacilliformis; for B. henselae observed one monopolar flagellum; or only saw. Bacteria have accurately structured three-layered cover; the last contains up to 12 proteins with a molecular weight from 174 to 28 kd. The size of a genome is rather small, within 1700-2174 in р; a ratio of guanine and a tsitozin - 38,5-41,0 pier. %. Reproduction of bartonellas happens simple transverse fission.

Grow in an organism of sensitive owners of a bartonella on a surface of cells, and also are implemented and occupy erythrocytes and endothelial cells of vascular system and an endocardium. Biological feature of bartonellas is their unique ability to stimulate proliferation of cells of an endothelium and growth of small vessels in their capillary part that leads to an angiomatosis.

On character of food of a bartonella are aerobic gematotrofa, exacting to composition of nutrient mediums. Out of a human body and rodents their cultivation can be carried out in clothes louses (B. quintana), cat's fleas (B. henselae), and also on the solid and semi-fluid nutrient mediums enriched with 5-10% of blood of the person or animals.

At primary allocation of bartonellas from biological samples (blood, bioptat of lymph nodes, pathological growths on valves of heart, papules and other bodies affected by a disease) the sick person needs long, to 15-45 days and more, keeping of the sowed cups with an agar in optimal conditions of growth.
Allocation of bartonellas from blood of patients, for example, in connection with an endocarditis at negative takes of seeding on other bacteria, or a lymphadenopathy after an otsarapyvaniye with a kitten or his sting, is considerably facilitated if to use lines of endothelial cells of other animals, and also such simple reception as centrifuging of blood with simultaneous destruction of erythrocytes.

Ecology. The ecology of bartonellas is studied insufficiently. Besporno is established endemicity of a disease-producing factor of Karrion - B. bacilliformis. It is widespread only in the Northwest of South America in mountainous areas of the Andes protected from the Pacific winds at the heights of 600-2500 m above sea level which are territorially tied to Peru, partially Colombia and Ecuador. A life cycle of these bartonellas is connected with the southern American kind of mosquitoes-flebotomusov, namely, Lutzomia noguchi, L. verrucarum and others, and also local mouse-like rodents.

Apparently, disease-producing factors of cat's scratches (cat scratch disease - English) and trench fever which carriers are, respectively, cat's fleas and clothes louses of the person are the most widespread. The last are almost ubikvitarny insects, their participation in a transimissiya of bartonellas of a quintant and Henseli in a human body is proved and, obviously, the bartenelleza caused by these two species of microorganisms are widespread on all globe within places of constant dwelling of people. In particular the bacteremia among cats and kittens connected with B. henselae in some states of the USA and also in Germany, especially among animals (to 89%) from those families in which children or owners of cats had a disease of cat's scratches is established high (to 68,1%).

Broad search of bartonellas in natural population of rodents in various countries (the USA, Bolivia, Paraguay, British Columbia (Canada), Poland and others) revealed high prevalence of bartonellas in natural population of rodents, representatives cat's (pumas) and dog (coyotes). Studying of ecology and epidemiology of bartonellas continues.

Rather most pathogenic for the person of B. bacilliformis and B. quintana it is supposed that a significant tank of these activators is the person as the asymptomatic and soft forms of an infection which are followed by a long bacteriocarrier are registered. A natural tank for B. elizabethae also, apparently, are small wild mammals.

Epidemiology.  Obligatory registration of bartonelloses does not exist. It is known that in the years of World War I epidemic of trench fever on the battlefield in Europe which affected not less than 1 million soldiers burst. During World War II it revived in an epidemic form, but in much smaller scale. About 80 thousand people had. With the end of World War II of outbreak of trench fever stopped. About age of the infection connected with B. quintana, messages appeared in the early nineties when the activator was revealed as the reason of an opportunistic infection at HIV-positive persons. Serological and molecular and genetic researches in the different countries including in Russia revealed the hidden circulation of the activator among the population and its existence in population of louses. At the population of Ukraine specific antibodies to bartonellas of a quintant are revealed in all age groups in the range of 1,48-2,48%, in France - at 0,6% inspected, and the endocarditises caused by this type of bartonellas are confirmed at 76,4% in group of patients with an unspecified etiology of suffering (1995-1998).

Epidemic of trench fever is connected with clothes louses of the person at an epidemic sapropyra; it is caused by mechanical rubbing in of the infected excrements in skin raschesa. In excrements of louses of a bartonella of a quintant keep the zhiznensposobnost exclusively long - up to 1312 days. The natural tank of bartonellas of a quintant is not established so far, the person is considered the only source of an infection. At louses, unlike a typhous rickettsiosis, the bartonellosis proceeds asymptomatically, the microorganism remains for life (to 30-45 days), transovarial transfer is absent. At the person, in addition to sharply proceeding feverish disease, perhaps long (up to 2-5 years) the hidden asymptomatic carriage or in combination with chronically proceeding lymphadenopathy and an endocarditis.

Fleas of Cfenocephalides felis, also as well as clothes louses, unlike mites, during the life cycle eat repeatedly and are not picky concerning the prokormitel. Thereof they serially sticking to cats or rodents, in the environment easily catch bartonellas. In their organism Henseli's bartonellas remain over a year without influence on behavior and a way of life. In search of livelihood insects attack also the person.

The true number having the bartonellosis caused by Henseli's bartonella remains not clear. But it is known that in the USA, for example, in the early nineties the rickettsiosis, most widespread in this country, - spotty fever of the Rocky Mountains - was registered at the level exceeding 1000 cases annually whereas incidence of a disease of cat's scratches was estimated at 22 000 cases from which 2000 - were hospitalized.

Treatment of the Bartonellosis:

Causal treatment of a bartonellosis includes antibiotics: levomycetinum on 0,5 g 3-4 times a day; streptomycin intramusculary on 0,5-1,0 g a day; tetracyclines (natural or semi-synthetic) on 0,2 g 4 times a day.

In an acute phase of a bartonellosis Novarsenolum intravenously on 0,3-0,45 g once is highly effective each 3-4 days. In recent years at this disease even more often appoint ftorkhinolona: таривид or ципробай on 200 mg 2 times a day intravenously kapelno (3-5 days) with the subsequent transition to oral administration (7-10 days). Carry out also active disintoxication and antianemic (including hemotransfusions) therapy, gepatoprotektor, high doses of vitamins E, C, B12, folic acid, antigipoksant and predecessors of makroerg appoint (cytochrome C, cyto-IAC, etc.).

Outside treatment does not play an essential role at a bartonellosis. At accession of consecutive infection antiseptic agents, ointments with antibiotics, for acceleration of healing of ulcers, erosion - reparant, proteolytic enzymes can be used.